The surgical needleholder is a well known instrument by which a surgeon, or other medical operator, manipulates a surgical suture needle through either the skin or underlying tissue of a laceration being sutured, accurately to draw the edges of the laceration together with surgical suture thread. Surgical needleholders are disclosed, for example, in U.S. Pat. No. 2,863,459; No. Re 22,857 and No. 1,579,379. As described in those patents, the conventional surgical needleholder is composed of stainless steel and is essentially in the form of a specialized pair of pliers. By the use of the instrument, the surgeon may secure the suturing needle in the jaws of the instrument, and the instrument serves to guide the suturing needle to cause the needle to pierce the skin edges adjacent to the laceration, so that the edges may be drawn and held together by the suturing thread which is bonded to the needle. In this manner, the suture thread serves to close the laceration, with the apposition of the skin on either side of the laceration being achieved by the ligation of several knots.
Surgical suture material is usually packaged as a sterile length of thread, approximately 18 inches in length, which has been previously bonded to a usually curved, sharp surgical needle. After each stitch has been completed during a suturing operation, it becomes necessary to cut the unused length of the suture thread, so that the unused thread may be utilized for subsequent stitches, and so that the stitches may each be physically separate from one another.
It is the present prior art practice to cut the suture thread during the suturing operation with a separate pair of stainless steel surgical scissors. However, this entails a cumbersome sequence of manual operations for the surgeon. For example, for a right-handed person, the needleholder which has been operated by the right hand during the suturing operation, must now be transferred to the left hand, the left hand having previously been used to hold a pair of surgical forceps so as to draw the skin edges together into the proper position to enable the suturing operation to be performed. Accordingly, in following the prior art practice, at the commencement of the cutting operation, the surgeon holds two instruments in his non-working left hand, and he must now pick up the scissors with his right hand in order to cut the thread.
The operation in picking up the scissors can become troublesome in that they may be located on a remote surgical tray, and they may be hidden under other instruments, so as not to be readily available. This, at the very least, creates a measure of distraction for the surgeon from the performance of the surgical process itself.
When the scissors have been located, in accordance with the prior art practice, they are held in the working right hand of the surgeon, and are used to sever the suture thread at a visually determined length from the knots, for example, from 1/8"-1/2". When the thread has been cut, the scissors must be returned to the surgical tray, or other location. In either event, there is a likelihood that the scissors may accidentally fall to the floor, or to another non-sterile surface, thereby necessitating the production of a new pair of scissors.
When the scissors have been returned to the surgical tray, or other location, the needleholder must now be returned to the right working hand, in carrying out the prior art practice, so that the next stitch may be commenced. The above described sequence of hand transfers of the instruments becomes even more troublesome when many stitches are to be inserted in the patient. For instance, in a long plastic surgical procedure requiring, for example, 40 stitches, forty sequences of instrument transfers must be performed.
In an attempt to avoid the sequences of instrument transfers described in the preceding paragraphs, combined needleholder/scissor instruments have been devised in the prior art. One such instrument is disclosed, for example, in U.S. Pat. No. 2,315,326. There are actually two popular types of combined needleholder/scissor instruments in the prior art.
In a first type of prior art instrument, a pair of opposing flat jaw surfaces are provided at the distal end of the instrument, while the working surfaces nearer the pivot pin are shaped as a pair of blades which operate as scissors.
However, the type of prior art instrument described above has inherent drawbacks. Specifically, the needle holding and thread cutting functions of the instrument are not independent of one another; so that when the cutting blades are being used, there is no needle holding capability, and the needle must therefore be held between the fingers of the operator. Moreover, as the blades of the instrument are being closed to cut the thread, the operator must be careful not to accidentally compress and destroy living tissue by the jaws of the instrument. Also, this particular type of prior art instrument does not possess a clasp mechanism to secure the needle while the suturing operation is being carried out, and the operator must always apply a closing force with his fingers, in order that the needle may be firmly held in the jaws of the instrument.
In a second type of prior art instrument which combines the needle holding and scissor functions, a cutting notch is provided on the outer side of the needle holding jaw. This latter type of instrument is provided with a clasp mechanism in order that the needle may be securely held in the jaws of the instrument when the jaws are closed. To cut the thread, the instrument is positioned so that the notch receives the thread at the point to be severed, and the instrument is squeezed so that the clasp moves to a tighter locked position, and when that occurs a blade moves across the notch to sever the thread.
When the latter prior art combination instrument is used, the cutting process does not possess the fine feel of a pair of scissors. In addition, the cutting operation is complicated by the fact that a substantial portion of the distal end of the instrument must be inserted into the wound in order to position the cutting notch properly to receive the thread, and this has dangerous implications.
The combined needleholder/cutter of the present invention is advantageous in that it obviates the need for two separate instruments in order to perform the needle holding and thread cutting functions. Also, the instrument of the present invention, as will become more apparent as the present description proceeds, has certain advantages over the prior art combination instruments in that the cutting function may be carried out independently of the needle holding function, and without any of the drawbacks of either of the prior art combination instruments.
Accordingly, a principal objective of the present invention is to combine the various instruments usually employed during suturing operations into a single instrument, so as to enable such operations to be performed with increased convenience and in less time. A feature of the instrument of the invention is that it is practically identical in configuration with needleholders presently being used so that a doctor accustomed to using the prior art instrument will have little trouble in adapting himself to the use of the combination instrument of the invention.